HIV Self-Testing: A supplementary strategy towards achieving the first 90 in inner city Johannesburg
HIV Self-Testing: A supplementary strategy towards achieving the first 90 in inner city Johannesburg
Project
This project will focus on the most challenging aspect of the UNAIDS 90-90-90 initiative, the first 90, getting people to know their status, using new, high-quality HIV self-tests. Additionally, the second 90 will be supported by ensuring linkage-to-care for newly diagnosed HIV positives using smartphone technology. Both oral and blood self-testing programmes will be assessed, and social harms will be monitored. The project will test 15 000 men, transgenders and sex workers, ensuring linkage to care for an estimated 3000 newly diagnosed HIV-positive patients.
Project details
Johannesburg
Objectives
This application addresses the following two interlinked problems:
1) Inadequate HIV testing options, with poor linkage to care
2) Inadequate testing of men, transgenders, discordant couples
Community groups
The project will test 15 000 men, transgenders and sex workers, ensuring linkage to care for an estimated 3000 newly diagnosed HIV-positive patients.
Background
South Africa is a middle income country with a high prevalence generalised HIV epidemic. The country has a commitment through the National Strategic Plan (NSP) to annual testing of all adults who are HIV-negative or of unknown status. South African HIV testing overall rates are higher than many other countries in the region, with over 65% of adults knowing their status (UNFPA, 2013; HSRC, 2014). However, re-testing of negatives, as well as efforts to getting to the significant number who are untested (a disproportionately large percentage of these are men), remains low. Immediate linkage to the next levels of care of newly diagnosed HIV-positive individuals is very low throughout the region (Rosen, PLoS Med. 2011). South Africa has the most severe gender disparity in terms of access to HIV testing and care services in the world, with women having met the first two 90s in UNAIDS targets. Men, however, remain under-tested, are less likely to link to care, access antiretrovirals at lower CD4 counts, and appear to be more prone to loss to follow up (HSRC 2013; Takarinda 2015) . It is estimated that only 60% of men eligible for HIV care are accessing it.
Stigma and other barriers to healthcare services mean that large segments of the South African population remain untested. Despite significant progress in testing rates, concern has been raised that conventional facility-based testing has several weaknesses, including long waiting times, needless repeat counselling, the identification of HIV-negative people within the public testing programme without a subsequent effective prevention message, poor quality control on the part of testers in terms of test administration, and the inability to reach key and vulnerable populations.